4: Trauma Flashcards
What was the original definition of trauma and what 2 factors led to being put into the DSM as PTSD?
OG = Physical wound
War veterans + increased attention to interpersonal violence + domestic/ sexual = idea of psychological distress
How was trauma first defined in the DSM and what are some issues with its then definition?
Trauma = event outside + other xp range of usual human exp Issues... 1. Vague - usual human xp?? 2. Subjective
How did the definition of trauma change in the 4th version of the DSM in 1994 and what were some of its criticism?
more explicit definition
- inclusive = 60% increase in diagnosis
- Trauma comes with fear, helplessness + horror
Criticism…
- excluded psychological integrity - there may have been no actual physical life threat but can still lead to trauma
How is trauma defined in the DSM now?
more explicit
- need specific event which is stressful
- only definition that is not theoretical
1. need actual threat - directly
- witness
- learning
- xp repeated exposure to details of threats (vicarious)
2. - fear no longer needed since other emotions may be more prevalent eg shame, anger, guilt (Friedman et al, 2011)
The current definition of trauma exclude what type of vicarious trauma (criteria D)?
- electronic media
What % of trauma patients are thought to be the result of hearing stories from traumatic survivors (vicarious) and what consequence does this have for people working with traumatic patients/ situations?
15-20%
Arvay + Uhlemann, 1996
- need to help + accommodate for those working in the front like eg paediatricians/ nurses
The loss of loved ones = not considered traumatic. What issue does this bring up about the definition of trauma?
Is it possible to objectify what is traumatic?
- you cannot assume details + reactions will be the same
= individuals capacity to deal with event
How does considering individual capacity change what is considered to be traumatic?
- event only traumatic if it overwhelms their capacity to deal with it
- response is important more so than event
Why is individual capacity important for children in defining what is traumatic?
- at least 2/3 of children xp adverse events (Anda + Felitti, 2003)
- these adverse events considered not to be traumatic according to DSM (Verlinden et al, 2013)
What are the categories which are adverse childhood xp not considered traumatic by DSM?
- Emotional abuse
- swearing, putting down, hostility - Physical abuse
- push, slap, hit
= physical + emotional neglect
- absence of something positive = love, reinforcement = develop symptoms of PTSD
- Parents being treated violently
- Substance abuse, mental illness/ parent imprisoned in home
How common is trauma?
very
- 50/80% of Americans exp at least once (Alonso et al, 2002)
- SA = higher base line due to prevalence of war + violence
(Atwoli et al, 2013)
- 64% at least one traumatic xp in life time - Europe (Darves-Bornoz et al, 2008)
What was found when analysing people who had experienced trauma in Italy?
- 56% at least one traumatic events
- avg = 4 traumatic events
- trauma = from network events
- hearing child abuse
ISSUE: - some events more easy to asses
eg Italy = catholic = less sexual abuse
What are some factors which can influence the statistics of traumas?
- can co-occur
- eg: sexual violence + threatened death (Dong et al, 2004) - gender differences in trauma (Briere + Elliott, 2003)
- sexual violence higher in women
- not shown in stats - Geographical difference in trauma
new Orleans = more likely to xp death of close fam + friend
What can the consequences of trauma be?
- PTSD
- Eating disorders
- Depression
What are the symptoms of PTSD?
- vivid re-xp
- numbing feeling
- avoid similar situations/ heightened sense of threat
- intensified feelings about what happened
What are 2 explanations for what allows PTSD to persist as cause is unclear?
- Incomplete processing of event
- lack memory capacity to process = memory detached - meaning attached to xp
- blaming self for something they couldn’t stop
What are the DSM criterion for PTSD?
Ca. stressor event
Cb. intrusion stressor - re-xp persistently
- need at least 2 like nightmares/ reminders
Cc. Avoidance
- conscious effort to avoid talking about it
- changes in life style to avoid exposure
Cd. Changes in cognition + mood
- self-blame
- flattened effect
Ce. Arousal + reactivity
- even after, arousal is heightened
Cf. Duration
Cg. Functional significance
Ch. Attribution
- so disturbance not due to medication or substance use etc
What is PTSD?
The continuous feeling of threat even when it is over
PTSD figures are lower than Trauma, but how prevalent is it in comparison?
- 8.3% develop PTSD US (Kilpatrick et al, 2014)
- 1-7% gen pop (Wittchen et al, 2011)
- UK, France, Germany = highest prevalence
What was found to be source of most trauma in UK, France + Germany and WHY?
- Relationships
- affluent countries have basic needs met so focus on relationships
vs less affluent
Rates of PTSD are higher in what populations?
- women
- War veterans (Fulton et al, 2015)
- Child soldiers in Africa
- Ambulance personnel
What treatment is thought to be KEY for traumas and WHY?
Emotional processing
- you have…
1. Effective processing - emotional disturbance absorbed = no arousal when you remember
2. Ineffective processing - arousal still when you remember
How can you test is processing has taken place properly of traumatic events (emotional processing)?
Probe methodology: - expose them to a trigger IF... - negative reaction = not processed properly - No reaction = processed properly
What are the signs of ‘failed’ emotional processing?
- high lvl of arousal
- Intrusive thoughts + feelings
- Obsessions
- Flashbacks
- Nightmares
- Difficulty talking about event
What is the key focus of treatment trauma: emotional processing?
How are you processing the event after the event?
- focus: changing of memory structure of event
How are emotions and memory connected?
Amygdala - Emotions
Hippocampus - Memory
- close in proximity in the brain
- so when emotions are aroused, if strong enough = hippocampus also aroused
= SO degree of emotional arousal during event encoding correlates highly with recall (McGaugh, 2004)
What did Payne et al, 2008 do suggesting the importance enduring emotional memory and sleep?
so sleep deals with emotions but what about the arousal….
Trauma can be effectively processed
= war children who had fragmentes dreams they would process it better = better recovery = linked to well-bein
Punamaki et al, 2005
part 1: Shown one 2 pictures of cars
- emotional object (image) = higher recognition (30min + 12hrs later)
Part 2: Sleep
- Sleep group = emotional object consolidated = better recognition rate of emotional object
- Awake group = memory faded
= sleep selectively preserving emotional objects
Sleep deals with emotions but what about the arousal?
= REM important in preserving + removing arousal of event
- memory being associated with other experience + contextualised
= REM highly associative +
= diffuse impact of emotions stimuli (Van der Hel, et al, 2011)
What did punamaki et al (2005) find about war children who recovered from trauma?
- those who had fragments dreams = better dealing with it
sleep + REM - emotions + arousal contextualised + diffuse impact of emotional stimuli
What did Dekel + Bonanno (2013) find suggesting a link between trauma + memory?
49 adults who saw 9/11
- resilient people were changing memory = becoming more benign
- others recalled with unchanging memory = exp PTS
How can PTS = PTSD?
-
- og memory not effectively processed
- ppl tend to avoid as trauma has a lot of emotional charge
- effective processing requires emotional engagement w/ event Foa + Kozak 1986
- compounded problem ad sleep is affected = sleep + avoidance = memory kept alive
What is rumination?
repetitive self-focused thinking about the past
(Nolen-Hoeksema 1991)
- rumination - avoidance strategy
95% of PTSD ruminate Michale et al 2007
Avoidance is key to ineffective processing. What avoidance techniques are there = persistent PTSD?
- Rumination
- ruminating driving OGM - Processing of anxiety
- worry + ruminating = both verbal-conceptual
How is autobiographical memory organised?
hierarchical organisation
- lifetime periods
- general events
- event-specific knowledge
- as you move down, more emotions get attached
- from abstract to concrete specific
How is ruminating an avoidance strategy?
- rumination = verbal conceptual process vs sensory - perceptual
- PTS = affects the retrieval of autobiographical memories
= Overgeneral autobiogrpahical memory (OGM) - PTSD = increased lvl of OGM (williams et al, 2007)
What difference was found between the worries and those who were relaxed when asked to think about giving a presentation?
- worry = little change in heart rate
- relaxed = big changes in heart rate
worry similar to ruminating = avoidance = both verbal-conceptual
Avoidance impedes effective emotional processing (not just verbal processing).
So what should the focus of therapy be and what are some issues to consider?
d
Focus on effective emotional processing
- Exposure to engage - but have to be sensitive
What are the 2 different approaches to the treatment of PTSD?
- Prevention
- immediate exposure before PTSD develops
- within 72hrs
- via psychological briefing - Treatment after PTSD developed
- pharmacological treatment
- Trauma-focused psychological therapy
What is Psychological debriefing?
- encourage them to discuss them in as much detail as possible
- looking for sensory detail
- to help integrate memory
What are some problems of psychological debriefing?
- practically challenging if there are too many people
- could actually increase change when they aren’t ready = negative consequences
Rose et al, 2002
those who received debriefing has greater risk of developing PTSD one year later
What is trauma-focused psychological therapy?
- let them process naturally
- Help those who develop PTSD naturally
- 2 views:
- Exposure view
- to engage - Cognitive view
- works with meaning/ interpretation of event
What are some exposure-view techniques?
- written narrative
- visualise
- VR
whatever is appropriate for them
What did Foa et al (1991) find and what does it support?
exposure therapy = not benefits initially
followed up = exposed therapy better response in PTSD vs alt therapy like coping skills training etc
What is the cognitive view or trauma-focused psychological therapy?
- trauma = negative appraisal about the event, self + world
= negative thoughts = changes in behaviour to avoid - focus is on interpretation of event
vis cognitive re-structuring
What happens in cognitive re-structuring?
- asked to xp event into new words
- more rational
- Trials shows trauma-focused CBT superior to stress management + no treatment (Bisson et al, 2007)
